Assignment: Patient Preferences And Decision Making

Assignment: Patient Preferences And Decision Making

The evolution of technology allows patients to have more access to information resulting in well-informed, educated patients. While it is great that patients are taking the initiative to play active roles in their healthcare, it comes with challenges. Working in labor and delivery, I have had many experiences with patient involvement in treatment and healthcare decisions. One reoccurring experience that patient involvement helps aid in best practice and incorporates them in healthcare decision-making is birth plans.

Birthing plans set expectations and standards of care couples expect during the laboring process (Hidalgo-Lopezosa et al., 2021). According to a study by Hidalgo-Lopezosa et al. (2021), birth plans in southern Spain resulted in fewer interventions and more natural birthing processes. While the utilization of birth plans creates a clear picture of how the patient wants their delivery to go, they can be challenging, especially when they are unwilling to deviate from the plan. When I first started working labor and delivery, the first bout of knowledge my preceptor shared with me is never to trust a pregnant woman. While she did not mean this figuratively, the patient’s status can rapidly progress or decline. This instability can create a need for evidence-based innovations the couple is unwilling to try or had not discussed when developing their plan.

De Campos Silva and Lopes (2020) concluded the need for couples to discuss their birth plans with their physician or midwife to ensure all possibilities are deliberated, and each party has a clear understanding of desires and possible outcomes. Initiating these conversations before delivery would help reduce the challenges healthcare providers at my organization face when handed a birth plan, especially when the plan does not align with unit policies and the American College of Obstetricians and Gynecologist recommendations. The biggest challenge I have faced is a delivery that resulted in a limp unresponsive newborn.

The mother’s demand for the newborn to be placed in kangaroo care impeded proper intervention outlined by the Neonatal Newborn Resuscitation Program. After much explanation, the mother allowed the newborn to be placed in the warmer, where the newborn was intubated and flown to a tertiary hospital. The newborn was diagnosed with a diaphragmatic hernia which prevented proper lung growth. The diaphragmatic hernia could have been diagnosed with ultrasound; however, the mother refused. While the patient had the right to create a birth plan, I feel frequent in-depth conversations with a physician or midwife could have helped this situation.

Patients have the right and should want to be active participates in their healthcare decisions. They should research and become educated but also value the expertise of their physician and other healthcare providers. Without the collaboration of patients and healthcare providers, evidence-based practice is nonexistent (Melnyk and Fineout-Overholt, 2019).  Both must work together and use best practices to aid their decisions to improve health.  

 

References

de Campos Silva, T. M., & Lopes, M. I. (2020). The couple’s expectations for the birth

plan. Revista de Enfermagem Referência, 2, 1–7. https://doi-org.ezp.waldenulibrary.org/10.12707/RIV19095

Hidalgo-Lopezosa, P., Cubero-Luna, A. M., Jiménez-Ruz, A., Hidalgo-Maestre, M., Rodríguez-

Borrego, M. A., & López-Soto, P. J. (2021). Association between Birth Plan Use and Maternal and Neonatal Outcomes in Southern Spain: A Case-Control Study. International Journal of Environmental Research and Public Health, 18(2). https://doi-org.ezp.waldenulibrary.org/10.3390/ijerph18020456

Melnyk, B. M., & Fineout-Overholt, E. (2018). Evidence-based practice in nursing &

healthcare: A guide to best practice (4th ed.). Philadelphia, PA: Wolters Kluwer.

A profound situation that sticks out to me was when I was a surgical nurse. We had an oncology patient come in for tumor excision. Prior to the surgery I ran her urine POCT, and she was pregnant. She refused the surgery, understandably. The doctors discussed with her that chemo and radiation were her best option, however ultrasound had showed the baby was just into the second trimester. This was an impossible situation for me to imagine and still is. The mom decided to decline all treatments until after the baby was born. Just under a year later she was back, with the baby! We did the treatments as we originally planned, but the cancer had progressed and she did end up leaving on Hospice with CMO orders. Even so, she was absolutely at peace with this decision and thrilled that she had a healthy baby.

It is always important to consider patient preferences. The patient retains the right to choose. It is important that the patient can provide sound informed consent and agree to proceed with the procedure (Olejarczyk, 2022). The best way to approach situations like these is with shared decision making. Shared decision making includes establishing a trusting relationship with the patient; providing emotional support; assessing patients’ understanding of the situation; explaining the patient’s condition and prognosis; highlighting that there are options to choose from; explaining principles of surrogate decision-making; explaining treatment options; eliciting patient’s values, goals, and preferences; deliberating together; and making a decision (Kon et al., 2016).

There are decision aids for cancer. There are decision aids for each type of cancer. There are decision aids for pregnancy. Decision aids are a useful tool that help to easily organize the treatment options (McAlpine at al., 2018). It may be helpful to utilize decision aids in my future practice when patients need them. Ultimately, however this woman made her choice from love for her child, which no aid can help navigate.

 

References

Kon, A. A., Davidson, Judy, Morrison, W., M.D., Danis, M., M.D., & White, Douglas B,M.D., M.A.S. (2016). Shared decision-making in intensive care units: Executive summary of the american college of critical care medicine and american thoracic society policy statement. American Journal of Respiratory and Critical Care Medicine, 193(12), 1334-1336. Retrieved from https://www.proquest.com/scholarly-journals/shared-decision-making-intensive-care-units/docview/1797885427/se-2

McAlpine, K., Lewis, K. B., Trevena, L. J., & Stacey, D. (2018). What Is the Effectiveness of Patient Decision Aids for Cancer-Related Decisions? A Systematic Review Subanalysis. JCO clinical cancer informatics, 2, 1–13. https://doi.org/10.1200/CCI.17.00148

Olejarczyk, Jacob. (2022). Patient Rights And Ethics. https://www.ncbi.nlm.nih.gov/books/NBK538279/

Assignment: Patient Preferences And Decision Making

Changes in culture and technology have resulted in patient populations that are often well informed and educated, even before consulting or considering a healthcare need delivered by a health professional. Fueled by this, health professionals are increasingly involving patients in treatment decisions. However, this often comes with challenges, as illnesses and treatments can become complex.

What has your experience been with patient involvement in treatment or healthcare decisions?

In this Discussion, you will share your experiences and consider the impact of patient involvement (or lack of involvement). You will also consider the use of a patient decision aid to inform best practices for patient care and healthcare decision making.

To Prepare:

• Review the Resources and reflect on a time when you experienced a patient being brought into (or not being brought into) a decision regarding their treatment plan.
• Review the Ottawa Hospital Research Institute’s Decision Aids Inventory at https://decisionaid.ohri.ca/.
  • Choose “For Specific Conditions,” then Browse an alphabetical listing of decision aids by health topic.
• NOTE: To ensure compliance with HIPAA rules, please DO NOT use the patient’s real name or any information that might identify the patient or organization/practice.
•  Post a brief description of the situation you experienced and explain how incorporating or not incorporating patient preferences and values impacted the outcome of their treatment plan. Be specific and provide examples. Then, explain how including patient preferences and values might impact the trajectory of the situation and how these were reflected in the treatment plan. Finally, explain the value of the patient decision aid you selected and how it might contribute to effective decision making, both in general and in the experience you described. Describe how you might use this decision aid inventory in your professional practice or personal life.

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